Feasibility, effectiveness and transferability of a novel mastery-based virtual reality robotic training platform for general surgery residents (original) (raw)
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Performance Compared to Experience Level in a Virtual Reality Surgical Skills Trainer
Lecture Notes in Computer Science, 2007
A virtual reality (VR) manual skills experiment was conducted comparing Human performance measures to experiences indicated on a questionnaire handed out. How much do past experiences influence human performance on a VR surgical skills simulator? Performance measures included; time, accuracy, efficiency of motion and errors. Past experiences are among video games and computer proficiency. Results showed little or no relations between experience level and performance. Significant results could only be established for computer gaming experience versus task completion time, F(1, 22) = 3.3, p = .083. Participants familiar with computer gaming were able to carry out tasks faster than their counterparts.
Surgical Endoscopy, 2011
Background Virtual reality (VR) simulators have been demonstrated to improve basic psychomotor skills in endoscopic surgery. The exercise configuration settings used for validation in studies published so far are default settings or are based on the personal choice of the tutors. The purpose of this study was to establish consensus on exercise configurations and on a validated training program for a virtual reality simulator, based on the experience of international experts to set criterion levels to construct a proficiency-based training program. Methods A consensus meeting was held with eight European teams, all extensively experienced in using the VR simulator. Construct validity of the training program was tested by 20 experts and 60 novices. The data were analyzed by using the t test for equality of means.
Enhancing fundamental robot-assisted surgical proficiency by using a portable virtual simulator
Surgical Innovation, 2013
Background. The development of a virtual reality (VR) training platform provides an affordable interface. The learning effect of VR and the capability of skill transfer from the VR environment to clinical tasks require more investigation. Methods. Here, 14 medical students performed 2 fundamental surgical tasks-bimanual carrying (BC) and peg transfer (PT)-in actual and virtual environments. Participants in the VR group received VR training, whereas participants in the control group played a 3D game. The learning effect was examined by comparing kinematics between pretraining and posttraining in the da Vinci Surgical System. Differences between VR and playing the 3D game were also examined. Results. Those who were trained with the VR simulator had significantly better performance in both actual PT (P = .002) and BC (P < .001) tasks. The time to task completion and the total distance traveled were significantly decreased in both surgical tasks in the VR group compared with the 3D game group. However, playing the 3D game showed no significant enhancement of fundamental surgical skills in the actual PT task. The difference between pretraining and posttraining was significantly larger in the VR group than in the 3D game group in both the time to task completion (P = .002) and the total distance traveled (P = .027) for the actual PT task. Participants who played the 3D game seemed to perform even worse in posttraining. Conclusions. Training with the portable VR simulator improved robot-assisted surgical skill proficiency in comparison to playing a 3D game.
American Journal of Surgery, 2006
Studies have demonstrated the beneficial effect of training novice laparoscopic surgeons using virtual reality (VR) simulators, although there is still no consensus regarding an optimal VR training curriculum. This study aims to establish and validate a structured VR curriculum to provide an evidence-based approach for laparoscopic training programmes.The minimally invasive VR simulator (MIST-VR) has 12 abstract laparoscopic tasks, each at 3 graduated levels of difficulty (easy, medium, and hard). Twenty medical students completed 2 sessions of all tasks at the easy level, 10 sessions at the medium level, and finally 5 sessions of the 2 most complex tasks at the hard level. At the medium level, subjects were randomized into 2 equal groups performing either all 12 tasks (group A) or the 2 most complex tasks (group B). Performance was measured by time taken, path length, and errors for each hand. The results were compared between groups, and to those of 10 experienced laparoscopic surgeons.Baseline performance of both groups was similar at the easy level. At the medium level, learning curves for all 3 parameters reached plateau at the second (group A, P < .05) and sixth (group B, P < .05) repetitions. Performance at the hard level was similar between the 2 groups, and all achieved the pre-set expert criteria.A graduated laparoscopic training curriculum enables trainees to familiarise, train and be assessed on laparoscopic VR simulators. This study can aid the incorporation of VR simulation into established surgical training programmes.
American Surgeon, 2005
Given the dynamic nature of modern surgical education, determining factors that may improve the efficiency of laparoscopic training is warranted. The objective of this study was to analyze whether perceptual, visuo-spatial, or psychomotor aptitude are related to the amount of training required to reach specific performance-based goals on a virtual reality surgical simulator. Sixteen MS4 medical students participated in an elective skills course intended to train laparoscopic skills. All were tested for perceptual, visuo-spatial, and psychomotor aptitude using previously validated psychological tests. Training involved as many instructor-guided 1-hour sessions as needed to reach performance goals on a custom designed MIST-VR manipulation-diathermy task (Mentice AB, Gothenberg, Sweden). Thirteen subjects reached performance goals by the end of the course. Two were excluded from analysis due to previous experience with the MIST-VR (total n = 11). Perceptual ability (r = −0.76, P = 0.007) and psychomotor skills (r = 0.62, P = 0.04) significantly correlated with the number of trials required. Visuo-spatial ability did not significantly correlate with training duration. The number of trials required to train subjects to performance goals on the MIST-VR manipulation diathermy task is significantly related to perceptual and psychomotor aptitude.
Virtual Reality Training System for Anytime/Anywhere Acquisition of Surgical Skills: A Pilot Study
Military medicine, 2018
This article presents a hardware/software simulation environment suitable for anytime/anywhere surgical skills training. It blends the advantages of physical hardware and task analogs with the flexibility of virtual environments. This is further enhanced by a web-based implementation of training feedback accessible to both trainees and trainers. Our training system provides a self-paced and interactive means to attain proficiency in basic tasks that could potentially be applied across a spectrum of trainees from first responder field medical personnel to physicians. This results in a powerful training tool for surgical skills acquisition relevant to helping injured warfighters.
A Virtual Reality Training Program for Improvement of Robotic Surgical Skills
The purpose of this study was to use a simulated virtual reality environment for training of surgical skills and then to identify if the learning that occurred was transferable to a real world surgical task. The virtual surgical tasks consisted of bimanual carrying, needle passing and mesh alignment. In this ongoing study, the experimental group (n=5) was trained by performing four blocks of the virtual surgical tasks using the da Vinci surgical robot. Pre and post training, all subjects were tested by performing a suturing task on a "life-like" suture pad. The control group (n=5) performed only the suturing task. Significantly larger pre and post differences were revealed in time to task completion (p<0.05) and total distance travelled by the dominant side instrument tip (p<0.01) in the experimental group as compared to the control group. These differences were specific to the suture running aspect of the surgical task. In conclusion, virtual reality surgical skills training may produce a significant learning effect that can transfer to actual robot-assisted laparoscopic procedures.
Lack of transfer of skills after virtual reality simulator training with haptic feedback
Minimally Invasive Therapy & Allied Technologies
Background and Objective: Virtual Reality (VR) simulators enrich surgical training and offer training possibilities outside of the operating room (OR). In this study, we created a criterionbased training program on a VR simulator with haptic feedback and tested it by comparing the performances of a simulator group against a control group. Methods: Medical students with no experience in laparoscopy were randomly assigned to a simulator group or a control group. In the simulator group the candidates trained until they reached predefined criteria on the LapSim® VR simulator (Surgical Science AB, Sweden) with haptic feedback (Xitact TM IHP, Mentice AB, Sweden). All candidates performed a cholecystectomy on a porcine organ model in a box trainer (the clinical setting). The performances were video rated by two surgeons blinded to subject training status. Results: In total, 30 students performed the cholecystectomy and had their videos rated (N=16 simulator group, N=14 control group). The control group achieved better video rating scores than the simulator group (p<0.05). Conclusions: The criterion-based training program did not transfer skills to the clinical setting. Poor mechanical performance of the simulated haptic feedback is believed to have resulted in a negative training effect.
Virtual Reality Training Improves Operating Room Performance
Annals of Surgery, 2002
To demonstrate that virtual reality (VR) training transfers technical skills to the operating room (OR) environment. Summary Background Data The use of VR surgical simulation to train skills and reduce error risk in the OR has never been demonstrated in a prospective, randomized, blinded study. Methods Sixteen surgical residents (PGY 1-4) had baseline psychomotor abilities assessed, then were randomized to either VR training (MIST VR simulator diathermy task) until expert criterion levels established by experienced laparoscopists were achieved (n ϭ 8), or control non-VR-trained (n ϭ 8). All subjects performed laparoscopic cholecystectomy with an attending surgeon blinded to training status. Videotapes of gallbladder dissection were reviewed independently by two investigators blinded to subject identity and training, and scored for eight predefined errors for each procedure minute (interrater reliability of error assessment r Ͼ 0.80). Results No differences in baseline assessments were found between groups. Gallbladder dissection was 29% faster for VR-trained residents. Non-VR-trained residents were nine times more likely to transiently fail to make progress (P Ͻ .007, Mann-Whitney test) and five times more likely to injure the gallbladder or burn nontarget tissue (chi-square ϭ 4.27, P Ͻ .04). Mean errors were six times less likely to occur in the VRtrained group (1.19 vs. 7.38 errors per case; P Ͻ .008, Mann-Whitney test). Conclusions The use of VR surgical simulation to reach specific target criteria significantly improved the OR performance of residents during laparoscopic cholecystectomy. This validation of transfer of training skills from VR to OR sets the stage for more sophisticated uses of VR in assessment, training, error reduction, and certification of surgeons.
Updates in surgery, 2018
Proficiency-based training has become essential in the training of surgeons such that on completion they can execute complex operations with novel surgical approaches including direct manual laparoscopic surgery (DMLS) and robotically assisted laparoscopic surgery (RALS). To this effect, several virtual reality (VR) simulators have been developed. The objective of the present study was to assess and establish proficiency gain curves for medical students on VR simulators for DMLS and RALS. Five medical students participated in training course consisting of didactic teaching and practical hands-on training with VR simulators for DMLS and RALS. Evaluation of didactic component was by questionnaire completed by participating students, who also were required to undertake selected exercises to reach proficiency at each VR simulator: (1) 12 tasks on LapSim VR (Surgical Science, Gothenburg, Sweden) for DMLS, and (2) six selected exercises on the dV-Trainer Mimic (Seattle, WA, United States)...